title: Improving engagement in mental health treatment for home meal recipients with depression.
abstract: BACKGROUND
  Staff who provide support services to older adults are in a unique position to detect depression and offer a referral for mental health treatment. Yet integrating mental health screening and recommendations into aging services requires staff learn new skills to integrate mental health and overcome client barriers to accepting mental health referrals. This paper describes client rates of depression and a novel engagement intervention (Open Door) for homebound older adults who are eligible for home delivered meals and screened for depression by in-home aging service programs.
  
  
  METHODS
  Homebound older adults receiving meal service who endorsed depressive symptoms were interviewed to assess depression severity and rates of suicidal ideation. Open Door is a brief psychosocial intervention to improve engagement in mental health treatment by collaboratively addressing the individual level barriers to care. The intervention targets stigma, misconceptions about depression, and fears about treatment, and is designed to fit within the roles and responsibilities of aging service staff.
  
  
  RESULTS
  Among 137 meal recipients who had symptoms when screened for depression as part of routine home meal service assessments, half (51%) had Major Depressive Disorder and 13% met criteria for minor depression on the SCID. Suicidal ideation was reported by 29% of the sample, with the highest rates of suicidal ideation (47%) among the subgroup of individuals with Major Depressive Disorder.
  
  
  CONCLUSIONS
  Individuals who endorse depressive symptoms during screening are likely to have clinically significant depression and need mental health treatment. The Open Door intervention offers a strategy to overcome barriers to mental health treatment engagement and to improve the odds of quality care for depression.
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA.
authors.forename: Jo Anne
authors.initials: JA
authors.lastname: Sirey
authors.forename: Alexandra
authors.initials: A
authors.lastname: Greenfield
authors.forename: Alyssa
authors.initials: A
authors.lastname: DePasquale
authors.forename: Nathalie
authors.initials: N
authors.lastname: Weiss
authors.forename: Patricia
authors.initials: P
authors.lastname: Marino
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005522:Food Services; D006297:Health Services Accessibility; D018577:Homebound Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D036301:Qualitative Research; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: access to care; depression; engagement; mental health intervention